Blue Ridge Academic Medical Group, PLC

Primary specialty

Sports Medicine (Neuromusculoskeletal Medicine) PhysicianTaxonomy code 204C00000X

License

0102201473 Issued in VA

Legal business name

BLUE RIDGE ACADEMIC MEDICAL GROUP, PLC

Practice address

3700 S Main St
Blacksburg, VA 24060-7017

Phone

(540) 951-1111

NPI assigned

Mar 29, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Isaac J Kirstein, D.O.

Title

Physician

Phone

(540) 818-5890

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861453078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2265 KRAFT DR",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240606360",
            "telephone_number": "540-818-5891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 S MAIN ST",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240607017",
            "telephone_number": "540-951-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE ACADEMIC MEDICAL GROUP, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KIRSTEIN",
        "authorized_official_first_name": "ISAAC",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "540-818-5890",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "VA",
            "license": "0102201473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "279560",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DA5070",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Anna Blevins, LPTA
• Blue Ridge Optical
• Body Balance Spa, LLC
• Body Balance Therapeutic Massage
• Scott Boerth, M.D.
• Bolden Therapy & Wellness, LLC (Shameka Bolden)

• Sports Medicine (Neuromusculoskeletal Medicine) Physician in Blacksburg, VA
• Providers in Blacksburg, VA by specialty
• Sports Medicine (Neuromusculoskeletal Medicine) Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.